Provider Demographics
NPI:1043642341
Name:CORDOVA, VICTOR (PSYD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:CORDOVA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9033 BASE LINE RD STE A
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-1214
Mailing Address - Country:US
Mailing Address - Phone:909-922-2442
Mailing Address - Fax:909-999-2377
Practice Address - Street 1:9033 BASE LINE RD STE A
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-1214
Practice Address - Country:US
Practice Address - Phone:909-922-2442
Practice Address - Fax:909-999-2377
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-08
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29001103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical